Provider Demographics
NPI:1053643130
Name:A RAY LEWIS, DO, PLLC
Entity Type:Organization
Organization Name:A RAY LEWIS, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLPHUS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-413-0943
Mailing Address - Street 1:4732 E LANCASTER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3836
Mailing Address - Country:US
Mailing Address - Phone:817-413-0943
Mailing Address - Fax:817-413-0300
Practice Address - Street 1:4732 E LANCASTER AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3836
Practice Address - Country:US
Practice Address - Phone:817-413-0943
Practice Address - Fax:817-413-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2166936-01Medicaid
TX2166985-01Medicaid
TX0068TDOtherBLUE CROSS BLUE SHIELD
TXDQ6866OtherPALMETTO GBA RAILROAD MEDICARE
TX2166985-01Medicaid
TXTXB105773Medicare PIN